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Proefschrift binnenwerk Manon Ernst_DEF.indd

G E N E R A L   I N T R O D U C T I O N     Early  detection  of  obesity  and  prevention   Early  detection  and  prevention  of  obesity  in  an  at-­‐risk  population  is  of  utmost  im-­‐ portance.   One   has   to   identify   children   not   only   when   they   are   already   obese,   but   even  more  important  are  the  children  with  the  tendency  of  becoming  obese.  Multi-­‐ ple   strategies   to   prevent   obesity   in   children   are   available   worldwide,   but   most   of   them  are  applied  at  the  moment  a  child  is  already  overweight.  It  is  more  important   to  detect  the  predisposition  of  becoming  overweight  at  the  moment  a  child  still  has   a   healthy   weight.   For   that   reason   knowledge   of   the   longitudinal   growth   of   weight   and  height  of  a  healthy  reference  population  is  important.  This  information  is  avail-­‐ able  from  the  Dutch  longitudinal  growth  study  of  Gerver  and  de  Bruin45.  Out  of  the   original   data   of   children   from   birth   until   four   years   of   age   a   prediction   model   is   constructed   which   gives   the   opportunity   to   calculate   from   each   age   onwards   the   expected   height,   weight   and   weight   for   height   some   years   ahead.   If   the   actual   growth  pattern  of  an  individual  child  does  not  fit  into  the  expected  growth  pattern,   intervention  may  be  needed  to  prevent  obesity  later  on  and  thereby  reduce  the  risk   of  the  metabolic  syndrome.  Additionally,  the  question  arises  whether  the  study  data   of  the  reference  population  are  conform  the  actual  population  or  if  there  might  be  a   change  in  height  and  weight  due  to  a  secular  trend.  It  is  of  great  interest  to  know  at   what  age  during  infancy  this  secular  trend  in  weight  and  height  begins  and  if  this   trend  can  also  be  seen  during  intrauterine  growth.         As  mentioned  above  in  SGA  children  it  is  evident  that  the  increased  risk  on  the  met-­‐ abolic  syndrome  is  already  present  at  birth.  According  to  international  guidelines  a   subgroup  of  the  SGA  children  is  treated  with  human  growth  hormone  from  the  age   of  4  years  onwards.  Besides  an  increase  in  height  they  also  show  a  change  in  their   metabolism  resulting  in  a  shift  towards  less  fat  mass  and  more  fat-­‐free  mass.  It  is   assumed  that  this  shift  is  important  to  prevent  the  metabolic  syndrome.  The  ques-­‐ tion  arises  if  there  is  common  basis  for  the  development  of  the  metabolic  syndrome   between  the  two  groups  of  children,  obese  and  SGA.  Insulin  resistance  may  play  a   role  in  the  underlying  pathogenesis.   Outline  of  the  thesis   In  the  first  chapter,  an  overview  is  given  of  the  question  about  growth,  obesity  and   the  metabolic  syndrome.     In  the  second  chapter,  we  investigate  whether  the  increase  in  weight  is  related  to  a   secular  trend  in  height.  Furthermore,  it  is  discussed  whether  the  increase  in  weight   is  part  of  the  increase  in  height  or  goes  beyond  this.  A  second  aim  was  to  examine   whether  this  secular  trend  in  height  and  weight  is  already  visible  during  intrauter-­‐   17  


Proefschrift binnenwerk Manon Ernst_DEF.indd
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